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Psychiatric Comorbidity in Persons With Chronic Fatigue Syndrome Identified From the Georgia Population

From the Chronic Viral Diseases Branch (U.M.N., J.-M.L., E.M.M., J.F.J., H.T., R.S.B., W.C.R.), National Center for Zoonotic, Vector-borne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Psychiatry and Behavioral Sciences (U.M.N., C.L.R., C.H.), Emory University School of Medicine, Atlanta, Georgia.

Address correspondence and reprint requests to William C. Reeves, Centers for Disease Control and Prevention, Mail Stop A-15, Atlanta, GA 30333. E-mail: wcr1{at}cdc.gov

Objective: To compare the prevalence of psychiatric disorders in persons with chronic fatigue syndrome (CFS) identified from the general population and a chronically ill group of people presenting with subsyndromic CFS-like illness ("insufficient symptoms or fatigue" (ISF)). Previous studies in CFS patients from primary and tertiary care clinics have found high rates of psychiatric disturbance, but this may reflect referral bias rather than true patterns of comorbidity with CFS.

Methods: We used random digit dialing to identify unwell individuals. A detailed telephone interview identified those with CFS-like illness. These individuals participated in a 1-day clinical evaluation to confirm CFS or ISF status. We identified 113 cases of CFS and 264 persons with ISF. To identify current and lifetime psychiatric disorders, participants completed the Structured Clinical Interview for DSM-IV.

Results: Sixty-four persons (57%) with CFS had at least one current psychiatric diagnosis, in contrast to 118 persons (45%) with ISF. One hundred one persons (89%) with CFS had at least one lifetime psychiatric diagnosis compared with 208 persons (79%) with ISF. Of note, only 11 persons (9.8%) with CFS and 25 persons (9.5%) with ISF reported having seen a mental healthcare specialist during the past 6 months.

Conclusions: Our findings indicate that current and lifetime psychiatric disorders commonly accompany CFS in the general population. Most CFS cases with comorbid psychiatric conditions had not sought appropriate help during the past 6 months. These results demonstrate an urgent need to address psychiatric disorders in the clinical care of CFS cases.

Key Words: chronic fatigue syndrome • psychiatric disorders • population-based study

Abbreviations: CFS = chronic fatigue syndrome; CI = confidence interval; DSM = Diagnostic and Statistical Manual for Mental Disorders; ISF = insufficient symptoms or fatigue; OR = odds ratio.